American Journal of Nephrology

Patient-Oriented, Translational Research: Research Article

Yang C.-W. · Lin M.-C. · Shu K.-H. · Tung K.-T. · Tsai W.-C. · Yang J.-Y. · Pai M.-F. · Wu H.-Y. · Chiu Y.-L. · Peng Y.-S. · Hsu S.-P. · Wang S.-H. · Pan S.-Y.

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Article / Publication Details Abstract

Introduction: Although high dose erythropoiesis-stimulating agent (ESA) has been shown to increase mortality risk and adverse cardiovascular events in hemodialysis patients, the safety of extremely low dose ESA is unclear. Methods: We retrospectively analyzed the association between ESA dose and mortality in the monthly dosing range of 0-43,000 U of equivalent epoetin alpha in 304 Taiwan hemodialysis patients by using Cox proportional hazard model and cubic spline model. Results: Compared with mean monthly ESA dose of 15,000-25,000 U (mean ± standard deviation 20,609 ± 2,662 U), monthly ESA dose of less than 15,000 U (mean ± standard deviation 7,413 ± 4,510 U) is associated with increased mortality. Monthly ESA dose of 25,001-43,000 U (mean ± standard deviation 31,160 ± 4,304 U) is not associated with higher mortality risk than monthly ESA dose of 15,000-25,000 U. The results were consistent in Cox proportional hazard models and cubic spline models. Subgroup analyses showed no significant heterogeneities among prespecified subgroups. Conclusions: Extremely low dose of ESA in hemodialysis patients may be associated with increased mortality risk. Future studies are warranted to prove this association.

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